Procedure and machine for electro-inducing/stimulating deep layered muscle contractions using a biphasic faradic pulse sequence

ABSTRACT

A procedure and machine promotes healing by causing muscle fasciculation and contraction relaxation cycles that effectively pump blood through the microcirculation, draining the venous beds and raising the tissue oxygen levels. A high phase charged system is electronically pulsed and adjusted to induce deep-layered muscle contractions, causing greatly increased flow rates of both blood and lymphatics, patency of vessels permitting, and forcing blood into the microcirculation of the treated tissue. The machine electrical waveform stimulates angiogenesis, facilitating new tissue growth and repair in the healing process and raises the metabolic rate in the treated tissues.

BACKGROUND OF THE INVENTION

This invention generally relates to therapeutic treatment of human andanimal tissues and more particularly concerns a procedure and machinefor electro-inducing or stimulating deep layered muscle contractions intissues for the purpose of healing and treating wounds and variousvascular deficiency ailments such as peripheral vascular disease,ischemic rest pain, diabetic neuropathy, pressure ulcers, slow ornon-healing wounds, chronic low back pain, osteoarthritis, occupationalproblems such as carpal-tunnel syndrome, tendonitis and other sportsinjuries.

An underlying characteristic of the above conditions and diseases isimpaired circulation in the capillary beds as well as nerve damage.Without blood flow to the tissues, oxygen and nutrients cannot get intothe tissues and the waste products of metabolism cannot get out. Thisputs a severe stress on the tissues causing them to go into a survivalmode. The cells use what limited resources they have to stay alive andhigher functions, including healing and repair, as well as tissuemediated immunity, become essentially shut down. In most patients withsevere disease, measured tissue oxygen levels have been found to be lessthan 15% of normal. Diabetics with impaired basement membrane function,Reynauds phenomena, Claudication states and other similar conditions allmay have similar features due to this underlying characteristic.

Essentially, every tissue in the body has intrinsic electricalproperties. Because of this, it has been found that they respond toelectrical stimulation. There have been many machines designed over theyears to use electricity to affect the body in various ways to enhancethe healing process. There are many variables in the use of electricity,including polarity, voltage, amperage, frequency and waveform. Althoughthere are a variety of alternate technologies available today, theelectronic parameters of known machines have limited applications.

Hyperbaric oxygen therapy has been shown to be effective in healingischemic ulcers. 100% oxygen at 2 atmospheres will give a partialpressure of oxygen 10 times normal. This greatly increases the rate ofdiffusion through the open face of the ulcer. Skin, however, is not aspermeable to oxygen diffusion and oxygen delivery depends upon intactcirculation as well. Hyperbaric oxygen therapy is a passive process anddoes not alter the underlying disease in the microcirculation.

There are several procedures in practice using moist heat with occlusiondressings, infrared lamps, membranes with electrical currents and warmwater whirlpool treatments. These have all shown some merit and havebeen effective in varying degrees. They all work by stimulating thearterioles in the capillary beds to dilate in response to infraredenergy. These also are passive procedures, however, and do not alter theunderlying disease in the microcirculation.

Machines using high frequency interferential electrical currents arealso effective. They stimulate the nerves in the skin and cause dilationof the capillary beds through the reflex pathways. However, this form ofelectrical current tends to be more superficial in the tissues and,therefore, less decisive and rapid in its healing effects.

Another procedure being used today consists of a garment placed aroundthe diseased limb. Intermittent compression is then administered viacompressed air from the attached machine. This again has proven to beeffective to promote circulation and healing by pumping the bloodthrough the capillary beds. Pressure gradients are increased in thecapillary beds but there is not necessarily the dilation of thearterioles as the other methods promote. This procedure does not remodelthe microcirculation either.

It is, therefore, an object of this invention to provide an electricaltissue treating procedure and machine which increases circulation incapillary beds. Another object of this invention is to provide anelectrical tissue treating procedure and machine which significantlyremodels microcirculation so as to provide more permanent therapeuticimprovement. A further object of this invention is to provide anelectrical tissue treating procedure and machine which not only dilatesarterioles but also increases pressure gradients across the capillarybeds to improve flow and oxygen levels and promote angiogenesis. Yetanother object of this invention is to provide an electrical tissuetreating procedure and machine which provides deep layered musclecontractions and perfuses tissues with blood so as to afford moredecisive and rapid healing than known methods and machines. It is alsoan object of this invention to provide an electrical tissue treatingprocedure and machine which facilitates more rapid and decisive healingof vascular deficiency ailments than known procedures and machines.

SUMMARY OF THE INVENTION

In accordance with the invention, a procedure and machine are providedto promote healing by causing muscle fasciculation and contractionrelaxation cycles that effectively pump blood through themicrocirculation, draining the venous beds and raising the tissue oxygenlevels. This, in turn, supplies the oxygen and substrates necessary togreatly accelerate the healing process. Pressure gradients are actuallyincreased across the capillary beds with perfusion of blood into thedesignated area of the patient, in contrast to merely dilating thecapillary beds. Therefore, the treatment has a potent effect on themicrocirculation, which results in dramatic responses to treatment.Transcutaneous oxygen monitors have demonstrated marked increases intissue oxygen levels within minutes of initiating treatment. Tissueoxygen levels with successive treatments continue to improve.

A high phase charged system is electronically pulsed and adjusted toinduce deep-layered muscle contractions, causing greatly increased flowrates of both blood and lymphatics, patency of vessels permitting, andforcing blood into the microcirculation of the treated tissue.

The machine electrical waveform stimulates angiogenesis, that is,budding of new capillaries and generation of denser capillary networksin the tissues. This lays the groundwork for new tissue growth andrepair in the healing process. The machine electrical waveform alsoraises the metabolic rate in the treated tissues, which, it istheorized, helps the intimal lining of the arteries to metabolize theexcess unused nutrients clogging them. Whatever the actual cause, theeffect is improved blood flow that has been shown to be permanent,particularly in patients with neuropathy.

The procedure and machine have been tested on diabetics with severeischemic ulcers in feet that were destined for amputation. Thiscondition is usually associated with underlying osteomeyelitis, whichdoes not respond well to standard therapy including systemic antibioticsand wound care. The present treatment greatly improves the management ofthis condition because the enhanced blood flow brings enhanced levels ofantibiotics and healing to the affected area. In almost every case, thefeet have been salvaged.

In addition, the machine's electrical waveform directly stimulates theactivity of fibroblasts in the healing process. In the healing ofischemic ulcers the fibroblasts act first to build the framework uponwhich further cell types including skin and capillaries grow. Theelectrical current is a deep penetrating current that affects alltissues from the skin to the bone. Technically, the machine generates anelectromagnetic field between the emitter pads, in contrast to theelectrical waveform of some machines that stay rather superficial in thetissues affecting primarily the top several millimeters. The systemstimulates activity in bone cells as well, which accelerates fracturehealing.

Finally, the procedure and machine have achieved excellent test casesuccess in reversing neuropathy in the feet and legs of diabetics beingtreated. In follow up on this condition thus far, improvement haspersisted for extended periods of time. There is no other knowntechnology or treatment modality that has reversed diabetic neuropathy.The reason for this unique therapeutic benefit is not known. It may bedue to improvement in the circulation that nourishes the nerves or dueto an unknown direct action on the nerves themselves.

The procedure and machine have shown remarkable efficacy in dealing withthe above difficult disease states. In comparison with the currentalternative technologies on the market today, the present treatment hasproven to cause more rapid and decisive healing. In addition, thepatients have enjoyed permanent, persistent improvements in thecirculation of the affected limb.

A treatment regimen of forty-five minutes a day has been effective in avery high percentage of patients treated resulting in remarkable changesin both neural conductivity and wound healing rates. Most importantly,patients report a high level of comfort with treatment.

Even with a relatively high phase charge, the comfort level to thepatient remains acceptable over extended periods of time, during whichthe muscle groups are contracting. During moderate muscle contraction,blood rates can increase from 10 to 25 times the patient's resting bloodflow. While only 20 to 25 percent of muscle capillaries are open duringrest, nearly all of the dormant capillaries open up during moderatemuscle contraction. Because of the decreased oxygen concentration in thetissue fluid (because of increased oxygen demands from the contractingmuscles), vasodilation of the vessels is triggered by release ofadenosine and other vasodilator substances, to the extent that anyvasodilation is possible. In addition, lymph will not flow freely fromresting muscle. However, the contracting muscles will squeeze or pumpthe lymph vessels and capillaries resulting in increased flow rates.With this increased fluid perfusion due to passive repetitivecontractions (static work, an unopposed, involuntary muscle contraction)there is little lactic acid build up and most importantly there is moreoxygenated blood, due to the pumping action of the muscles exerted onthe arterial side.

As an example, take the lower leg as an area to be treated for healing adiabetic ulcer on the foot. The emitter pads are applied to the anteriorand posterior muscle compartments of the lower leg. This will achievemuscle contractions in the anterior compartment, consisting of theanterior tibial and the extensor group and of the posterior compartmentconsisting of the gastrosoleus, flexors and peroneals. As these musclespump oxygenated blood to the tibial and peroneal arteries and theirsmaller branches, the velocity and flow increases. The viscosity of theblood decreases and the red blood cells reach a desirable state ofdeformability. These erythrocytes are able, with increased velocity andellipsoidal shape, to reach tissue they were blocking or unable tomigrate through previously. In addition to the enhanced perfusion ofcompromised tissues, the increase in blood flow and passive exercise inoften debilitated muscles, reduces the effects of muscle disuse atrophy.This sets in motion a therapeutic cycle of increased mobility by thepatient. When walking and weight bearing is desirable, the patient isliterally contributing to their own improvement in circulatory status byincreased walking and well-being.

Prior to the procedure and machine herein described, there arewell-defined protocols for treatment of wounds. Many of these sameprotocols are followed in conjunction with the present methods. Asimilar example obtains with chemotherapy in the treatment of malignanttumors. In chemotherapy, besides attacking the target tumor, there arenumerous undesirable side effects. The side effects would be less if thechemotherapy dosage were reduced. The effect on the tumor would also bereduced, unless there were some means to make the tumor more susceptibleto the chemotherapy. It is found that the present methods have preciselythat effect by increasing fluid perfusion in the tumor and the vicinitythereof.

BRIEF DESCRIPTION OF THE DRAWINGS

Other objects and advantages of the invention will become apparent uponreading the following detailed description and upon reference to thedrawings in which:

FIG. 1 is a graphic representation of a typical computer generatedbiphasic pulse sequence;

FIG. 2 is an expanded time scale representation of the positive pulse ofFIG. 1;

FIG. 3 is a graphic representation of the amplitude spectrum of thebiphasic pulse sequence of FIG. 1;

FIG. 4 is an expanded frequency scale representation of the lowfrequency portion of the amplitude spectrum with an increased repetitionrate;

FIG. 5 is an expanded amplitude graphic representation of the positiveamplitude portion of the amplitude spectrum at the highest repetitionrate;

FIG. 6 is a graphic representation of the biphasic pulse correspondingto the amplitude spectrum of FIG. 5;

FIG. 7 is a graphic representation of the amplitude spectrum of abiphasic pulse sequence having a different pulse width than the pulsewidth of the sequence of FIG. 6;

FIG. 8 is a graphic representation of the amplitude spectrum of abiphasic pulse sequence having a narrower pulse width than the pulsewidth of the sequence of FIG. 6;

FIG. 9 is a graphic representation of a portion of a measured biphasicpulse sequence used in system analysis of the machine;

FIG. 10 is an expanded time scale graphic representation of the positivehalf of the pulse sequence of FIG. 9;

FIG. 11 is an expanded time scale graphic representation of the leadingedge of the positive pulse of FIG. 10;

FIG. 12 is an expanded time scale graphic representation of the trailingedge of the positive pulse of FIG. 10;

FIG. 13 is a graphic representation of the nonlinear relationship of themachine output voltage to the intensity level;

FIG. 14 is an expanded time scale graphic representation of the positivepulse waveform characteristics at low intensity level;

FIG. 15 is an expanded time scale graphic representation of the positivepulse waveform characteristic at a mid-range intensity level;

FIG. 16 is an expanded time scale graphic representation of the positivepulse waveform characteristics at a high intensity level;

FIG. 17 is a graphic representation of the normalized power spectraldensity for machine;

FIG. 18 is a graphic representation of a nominal spectral power densityfor a preferred embodiment of the machine;

FIG. 19 is a schematic block diagram of the electrical circuit of apreferred embodiment of the machine of FIG. 20;

FIG. 20 is a perspective assembly view of a preferred embodiment of themachine of the present invention;

FIG. 21 is a top plan view of the machine of FIG. 20;

FIG. 22 is a front elevation view of the machine of FIG. 20;

FIG. 23 is a side elevation view of the machine of FIG. 20; and

FIG. 24 is a flow chart illustrating the protocol of the presenttreatment procedure.

While the invention will be described in connection with a preferredembodiment, it will be understood that it is not intended to limit theinvention to that embodiment. On the contrary, it is intended to coverall alternatives, modifications and equivalents as may be includedwithin the spirit and scope of the invention as defined by the appendedclaims.

DETAILED DESCRIPTION

The machine applies the output of a biphasic faradic pulse generator toone or more sets of conductor pads oppositely applied to the area to betreated.

The following waveform analysis, based on use of computer generatedbiphasic pulses, was used to select and evaluate the waveform of thegenerated pulse. It is believed that the benefits of electro-stimulationare related to the stimulation frequency components (see, e.g. Savage,Brenda, “Inferential Therapy,” Faber and Faber, London, 1984).Considering the biphasic pulse of FIG. 1 and expanding the time scaleabout the positive pulse as shown in FIG. 2, it is seen to be awell-formed rectangular pulse. This pulse validates the frequencyanalysis which is to follow with respect to the frequency spectralcontent of the biphasic waveform. For the most part, the periods of thebiphasic pulses are short in terms of the period of the overall pulsesequence, so the spectrum of the overall sequence can be represented bya Fourier series. Analytically, this is given by${p(t)} = {\sum\limits_{n = l}^{\infty}{{P\left( f_{n} \right)}\sin\quad 2\quad\pi\quad f_{n}t}}$Where P(ƒ_(n)) is the magnitude of the n-th frequency component, givenby${P\left( f_{n} \right)} = {{\frac{4}{T}\left\lbrack \frac{\sin\left( {2\quad\pi\frac{\tau}{2}f_{n}} \right)}{2\quad\pi\frac{\tau}{2}f_{n}} \right\rbrack}\quad\sin\quad\left( {2\quad\pi\frac{T}{4}f_{n}} \right)\quad{where}}$

-   -   τ=the individual pulse width and T=the biphasic pulse period        The first thing to note is that in frequency space, the factor        in the brackets is a relatively low frequency envelope acting on        the higher frequency term outside the brackets. This is        exemplified by FIG. 3. The spectrum is shown only out to 100        kHz.

The period of the envelope is set by the individual pulse widths and theperiod of the high frequency components interior to the envelope are setby the biphasic s pulse period. This is the amplitude spectrum used toproduce FIGS. 1 and 2. To get the clean pulses previously shown it wasnecessary to use frequencies out to 1 MHZ. Typical of Fourier series,the convergence is rather slow.

To get a better picture of a typical spectrum, the magnitude of thelowest frequency can be increased by increasing the pulse repetitionrate, as indicated in FIG. 4. In FIG. 4, the actual values of thefrequency component amplitudes are indicated by the circles. Thecontinuous lines are only a visual aide. The high frequency componentsinterior to the envelope have been spread. In the previous spectrum, thehigh frequency components were so closely packed that they appeared tobe solid. The spectrum is actually discrete. In FIGS. 3 and 4, allpositive spectral components are followed by a zero amplitude componentand a negative going component, and conversely for all negative goingcomponents. There are multiples of the fundamental missing.

Turning to FIG. 5, the biphasic pulse period is reduced to its lowerlimit with the pulse width at its upper limit. There is one dominantfrequency component with minimal high frequency content, as might beexpected, considering that the corresponding biphasic pulse is beginningto approximate a pure sinusoid, as is shown in FIG. 6.

The above analysis shows, by reference to FIG. 5, that the lowestfrequency available is 1 kHz with minimal higher frequency content. Thisalso applies to FIG. 7 where the lowest frequency available is set bythe biphasic repetition rate. For this repetition rate, changing thepulse width has minimal effect.

Considering the situation with the lowest pulse repetition rate as shownin FIG. 3, there is much higher concentration of the pulse energy at thelower frequencies with a substantial amount of energy at the higherfrequencies. Looking at FIG. 8, the narrowing of the pulse has spreadthe frequencies to higher values. The lowest frequency is 10 Hz.

Interferential therapy tells us that, “ . . . for each type of excitabletissue there is an optimum frequency at which the maximum response willbe obtained.” (Savage, op.cit.) The frequencies lie between 0 and 130Hz. The lower frequency repetition rates appear to be the mostfavorable. An infinite pulse train has been assumed, an assumption whichis worst for the lower repetition rates. Resolution of this assumptionwill render the spectrum continuous rather than discrete. The mostfavorable pulse sequence appears to be 10 Hz repetition and 250 μs pulsewidth, although some of the region below 10 Hz would be lost. However,the spread spectrum permits a large number of tissue types to beaffected.

Following the above computer generated waveform analysis, measured datawas obtained using prototypes of the machine. The data was measured atis full intensity into a load of 50 Ω. The output of the system was asequence of biphasic pulses, with a sequence duty cycle of 1.5 secondson and 1.5 seconds off. A portion of one sequence is shown in FIG. 9,having a biphasic period of 17.5 ms and a repetition frequency of 57 Hz.In 1.5 seconds, the machine delivers 86 biphasic pulses to the patient.

The positive half of the biphasic pulse is shown in FIG. 10 and has azero-to-zero pulse width of 110 μs. The leading edge, displayed on anexpanded time scale in FIG. 11, has a 10 to 90 percent rise time of justunder 8 μs. The trailing edge, seen in FIG. 12, has a fall time of 9 μs.The negative going half has essentially the same characteristic as thepositive going half.

Two key parameters concerning the interaction of the system with thepatient are the open circuit voltage and internal impedance. There aretwo ways of changing the system loading: placing a resistance in seriesor placing a resistor in parallel.

The following parameters are assumed:

-   -   V_(O)=Microvas open circuit voltage    -   R_(S)=Microvas source resistance    -   I=Microvas current    -   R_(O)=measurement system input impedance    -   R_(L)=The added load resistance    -   V_(m)=The voltage at the measurement system input

In the series load case, the Microvas current is given by I=V_(m)/R_(O)with the Kirchoff equationsV _(O) −I ₁ R _(S) =I ₁(R _(L1) +R _(O))V _(O) −I ₂ R _(S) =I ₂(R _(L2) +R _(O))

The immediate determanantal solution is$R_{s} = {{\frac{{I_{2}\left( {R_{L2} + R_{o}} \right)} - {I_{1}\left( {R_{L1} + R_{o}} \right)}}{I_{1} - I_{2}}\quad{and}\quad V_{o}} = {\frac{I_{1}I_{2}}{I_{1} - I_{2}}\left( {R_{L2} - R_{L1}} \right)}}$

In the parallel case, the Microvas current is given by$I = \frac{V_{m}\left( {R_{L} + R_{o}} \right)}{R_{L}R_{o}}$

-   -   with Kirchoff equations        V _(O) −I ₁ R _(S) =V _(m1)        V _(O) −I ₂ R _(S) =V _(m2)

Again, an immediate determanantal solution is given by$R_{s} = {{\frac{V_{m2} - V_{m1}}{I_{1} - I_{2}}\quad{and}\quad V_{o}} = \frac{{I_{1}V_{m2}} - {I_{2}V_{m1}}}{I_{1} - I_{2}}}$

The measurements were made with an oscilloscope preceded by a 40 dBattenuator. The input impedance of the system is 50 Ω. Thus the parallelcase can only vary the effective loading of the Microvas from 0 to 50 Ω.In use, it appears that the expected loading would be on the order of500 Ω, so the parallel case was not used in our tests; all measurementswere made with series loading. Slight variations in pulse shape were TheMicrovas source and open circuit voltage were determined by usingvarious combinations of loading resistances and intensity set at 10,with the following results. R_(L1)/Ω R_(L2)/Ω R_(s)/Ω V_(o)/V ΔV_(o)2016.7 5150.0 417.7 130.3 4.3 1503.7 2016.7 425.0 134.6 6.5 50.8 511.7507.6 141.1 0.7 0 511.7 512.9 141.8 6.7 0 50.8 539.3 148.5

Assuming a design goal of a source impedance of 500 Ω with an opencircuit voltage of 140, adjustments were made to achieve this with aload impedance of 500 Ω.

As shown in FIG. 13, the output voltage is a nonlinear function of theintensity setting. Clearly, the numbers associated with the intensitysetting potentiometer are not representative of the relative appliedvoltages. The variation of waveform characteristic with respect tointensity setting is represented by FIGS. 14 (low intensity), 15(mid-range intensity) and 16 (full intensity).

While there is some indication that the wave shape has some degree ofsignificance, in which case variation in pulse shape with intensity isan undesirable effect, there is more importantly an indication thatspectral content is significant and, as shown, the preferred envelope ofthe spectrum is dominated by the pulse width, while the high frequencyvariations are dominated by the biphasic period. Therefore, the spectrumis not substantially altered by the fine details of the pulse shape solong as it has a reasonable semblance to a rectangular pulse. Whilethere is some variation in pulse width, it is not of sufficientmagnitude to be significant. This also applies to variations fromchannel to channel.

While the waveforms observed are not ideally square, they aresufficiently close to provide a reasonably good estimate of theirspectral content using the formula presented earlier. For evaluationpurposes, the normalized power spectral density, shown in FIG. 17 is ofgreater interest than the spectral amplitude.

It is possible that radio frequency components could have adverseaffects. While the definition of a radio frequency is not precise, radiofrequencies are, for this disclosure, deemed to be those above 10 kHz,the upper end of the audio spectrum being about 20 kHz. On this basis,the preponderance of the spectral power is below radio frequencies. Thenominal pulse width is 180 μs. The resultant spectrum, shown in FIG. 18,displays no significant radio frequency components.

Based on the above analysis, measurements, and clinical results, thecharacteristics of an effective biphasic faradic pulse waveform werefound to be: duty cycle, 1.5 s on 1.5 s off; repetition frequency, 57Hz; pulse width, 110 μs.

Turning to FIGS. 19 through 23, the basic components of the machineinclude a timer 31 which controls operation of both the pulse generator33 and a speaker 35. The output of the pulse generator is made availableat eight terminals 41 through 48. Each of the terminals 41 through 48can be connected by a separate pair of leads 51 and 52 to a pair ofemitter pads 53 and 54, respectively, as will be hereinafter discussed.The power source 34 for the system is a pair of rechargeable batteries34, preferably, 12 V/y.5Ah rechargeable sealed-lead-acid batteries. Themachine also includes a battery charger connectable to a 120 voltsource. The system is configured to interrupt power if the machine isconnected to any 120 volt source. Looking at FIGS. 20-22, cliniciancontrol of the system involves the power ON/OFF switch 35, a duty cycleON/OFF switch 36, and eight intensity potentiometers 61 through 68, onefor each of the terminals 41 through 48, respectively. The intensitypotentiometers 61 through 68 click between an OFF position and an ONposition in which the intensity may be varied in ten incrementsincreasing from intensity settings of 1 through 10. The system isconfigured so that, if any of the intensity potentiometers 61 through 68are not in the clicked OFF condition, operation of the duty cycle switch36 will not activate the system. If the power source 34 is sufficientlycharged, if the system is not connected to a 120 volt source and if theintensity potentiometers 61 through 68 are all clicked OFF, upon theoperation of the power switch 32, power is available to the system underthe control of the timer 31. If power is available and the intensitypotentiometers are all in the clicked OFF condition, when the clinicianinitiates the duty cycle by pressing the duty cycle switch 36, the pulsegenerator 32 begins to deliver the output signal to the output terminals41 through 48 via the intensity potentiometers 61 through 68.Immediately a digital display 37 on the machine control board indicatesthe time remaining in the duty cycle in one minute increments. In thepreferred embodiment, the duty cycle is set at 45 minutes. When the 45minute duty cycle has elapsed, the timer 31 will disconnect power to thepulse generator 32 and cause the speaker 33 to give an audible signalindicating that the duty cycle has been completed. The power ON/OFFswitch 35 has an associated LED 75 indicating that the system is turnedON. The duty cycle switch 36 has an associated LED 76 which will flashcontinuously with the pulse status to indicate that the duty cycle is inoperation. The system is further configured so that, if the duty cycleis disabled because any one of the intensity potentiometers 61 through68 is not in the clicked-OFF condition, the duty cycle 76 led will flashrapidly ON and OFF until the condition is corrected. The battery chargerpower system is preferably a 120V AC @0.25 amps AC power entry modulewith integral fuse and switch. The power ON/OFF switch 35 and duty cycleswitch 36 are rocker type switches

The procedure for treatment is described in reference to FIG. 24. First,it must be determined whether the present treatment is appropriate forthe particular patient. This protocol is for the treatment of anycondition that can benefit from enhanced healing and repair through themechanisms of increased blood flow, nutrient supply, waste removal andcellular activity. A comprehensive list of treatable conditions isprovided at the end of this description, but some major examples includethe following:

-   -   a. Diabetic ulcers or ischemic ulcers in the bedfast or        neurologically compromised patient are characterized by        decreased healing due to ischemia and compromise in the        microcirculation, which the present treatment can enhance and        remodel;    -   b. Large decubiti requiring surgical closure with skin, fat or        muscle flaps can benefit from preheating before the closure by        improved blood flow, granulation, and epithelialization of wound        margins;    -   c. Sports injuries including sprains and strains can benefit        from more rapid healing due to the enhanced blood flow, the        increased activity of the fibroblasts and the reeducation of the        entire muscle mass as well as the ligaments and tendons;    -   d. Repetitive stress injuries such as carpal tunnel syndrome        characterized by an imbalance between the wear and tear in the        tissues and an inadequate healing and repair response usually        respond rapidly to the present treatment;    -   e. Chronic pain syndromes such as fibromyalgia and chronic low        back pain benefit from a decrease in pain and an increase in        flexibility and function;    -   f. Healing time for bone fractures can be decreased due to the        increased blood flow as well as the direct stimulation of the        bone by the present electrical waveform;    -   g. Ischemic rest pain conditions due to arterial insufficiency        can be improved with the present treatment;    -   h. Degenerative arthritic conditions including osteoarthritis        and degenerative joint disease can be improved through the        enhanced blood flow and healing of the present treatment;    -   i. The present treatment will positively reverse diabetic        neuropathy and keep it reversed.    -   j. The procedures described herein can be used to increase the        effectiveness of chemotherapy treatments, leading to reduction        in the chemotherapy deleterious side effects.

To determine the appropriateness of the procedure, inspect the area forischemic necrosis that is extensive enough to put the patient at riskfor infection that would be limb threatening and require surgicalintervention. Check for gas gangrene by crepitus to palpation and gas inthe limb on x-ray. While the present treatment can improve circulationand the resistance to infection in the limb fairly quickly, if thecondition is too advanced with ischemic necrosis and advancing gasgangrene present involving more than a toe or two, it is best to proceeddirectly to surgical intervention. Manageable cellulitis is not acontraindication. The present treatment can aid in resolving theinfection. Any patient with blood clot problems of any kind is acontraindication to the present procedure. The procedure is alsoinappropriate in cases of deep and superficial thrombophlebitis,pregnancy, and placement of emitter pads above the waist on patientswith demand-type pacemakers.

If the present procedure is appropriate proper wound care must be givento the patient with open or infected decubitus following currentstandards including daily inspection, sterile technique, appropriatedebridement, cultures and antibiotics when indicated and properdressings.

The machine and peripheral equipment should be inspected and preparedfor each use. Use one or more clean disinfected pairs of emitter padssoaked in normal sterile saline, but not dripping wet, for eachtreatment. Following the treatment, rinse the pads in clean water andsterilize them using steam or chemical sterilizing agents. Let the padsair dry out unless they are to be used again immediately. Wipe down thecarbon rubber emitter pads and leads with a chemical-sterilizing agent.If the equipment becomes contaminated with blood, pus or bacteria, wipeit down with a damp cloth soaked in a chemical sterilizing agent. Forbest results charge batteries over night if used during the day.

The patient should be placed in a comfortable position, lying or sittingso the muscles in the area of treatment can remain relaxed. Allow thearea of treatment to be exposed, without pressure from the weight of thelimb or body, to allow the stimulation of the circulation by thetreatment.

Typically, the choice of emitter pads may be round, on the order of oneto four inches in diameter, or rectangular on the order of one by twoinches to eight by twelve inches, though different configurations andsizes may also be appropriate for specific body contours. Place thelargest emitter pads that can be physically placed adjacent to the areato be treated. Use one to four pairs of emitter pads surrounding thearea such that each pair cause the current to flow through the area oftreatment. Place an additional pair or two pairs of emitter pads on theopposite sides of the large muscle masses of the limb proximal to thearea of treatment. This will aid blood flow in the larger vessels thatsupply the area to be treated and aid in the lymphatic drainage from thearea. For example, one emitter pad may be placed over the quadricepsmuscle with it's mate placed over the hamstrings about mid body. Theemitter pads must be secured with just enough pressure to cause fullcontact with the skin but not too much such that blood flow might becompromised to the area. Partial emitter pad contact could cause apainful concentration of the current. Ensure that the positive andnegative emitter pads do not touch. If this occurs, the current willshort between the emitter pads and not provide therapeutic benefit tothe patient. Do not place the emitter pads over the heart, neck or head.

It has been experimentally determined that the optimal duration oftreatment is 45 minutes twice a day, but a single 45 minute treatment 5days a week is also effective but taking a longer time to reach fulleffectiveness. The typical treatment condition would be a severediabetic ischemic foot ulcer that is in jeopardy of amputation. Thiswill require several weeks of treatment at 45 minutes twice a day.Conditions like carpal tunnel syndrome will require about 10 treatmentsover a two week period while conditions like acute sprain will respondnicely to 5 or 6 treatments.

All of the electronic parameters have been optimized and the onlyvariable is intensity. When placing the emitter pads 53 and 54 on thepatient at the beginning of the treatment, the machine is turned offwith all dials 61 through 68 and switches 35 and 36 in the off position.With the power switch 35 on, begin the treatment by arming the timer 31(hold the duty cycle switch 36 on until the light begins blinking). Setthe initial intensity of current to about 3 or 4 on the intensitypotentiometer 26, incrementally adjusting upward the current on each setof pads 51 and 52 as the patient tolerates over the first 5 minutes. Donot adjust upward more than one number at a time. The patient willdevelop a rapid tolerance to the current and there will be a decrease inthe impedance of the tissues to the current as the body adjusts to it.About 4-5 initial adjustments will be necessary. Readjust upward totolerance after the first 10 minutes of the treatment.

Visible muscle contractions need to be achieved when the emitter pads 53and 54 are applied and positioned correctly. If there is a significantdegree of disuse atrophy, active observable muscle contraction may notoccur during the initial treatment session. Considerable edema may makeit difficult to observe muscle contraction. If there is no perception ofcontraction either by observation or by palpation of the musclecompartment, after the treatment is underway, then the emitter padcontact point may need to be checked for inadequate conduction ofcurrent. Repositioning may be necessary or more saline may need to beapplied to the emitter pads 53 and 54 to achieve the desired results.When a patient has extreme neuropathy and claims to feel no electricalcurrent, then the clinician may check the integrity of the emitter padby turning down the intensity and applying it to the back of his or herown hand. The intensity setting of each channel being utilized shouldalways be increased to the highest setting that the patient comfortablytolerates. At the highest tolerable setting, if there are very robustactive muscle contractions, the clinician may opt for decreasing theintensity slightly to avoid fatigue and soreness, particularly in theinitial few treatments. Always review the patients perception andimpression of the previous treatment as per the treatment chart.

When the 45 minute treatment is over, a buzzer will sound. Then all theintensity switches should be turned off. Remove the equipment andinspect the area for response to the treatment (pink flush isdesirable). Check for any complications of infection. Properly dressdecubiti following standard wound care protocol. If available, check thetranscutaneous pulse oximetry before and after treatment. Document theinitial condition of the treated area with diagrams, drawings orpictures as well as at least weekly progress. Take measurements of thediameters of decubiti. A Comprehensive List of the various Conditionsthe Invention Can Successfully Treat Neuropathy 1. Diabetic neuropathycode insulin dependent or not. 2. Diabetic neuropathy of the Feet 3.Peroneal palsey “drop foot” 4. Bells palsey of the face 5. TrigeminalNeuralgia 6. Sciatica - see condition 7. HIV Neuropathy - 8. Tarsaltunnel syndrome 9. Alcoholic polyneuropathy 10. Hereditary progressivemuscle 11. Hereditary progressive muscle dystrophy 12. Paresthesia feetNOS 13. Paresthesia hands NOS 14. Ulnar nerve lesion 15. Foot neuromametatarsals 16. Chemotherapy induced neuropathy 17. Neuropathy ofPernicious anemia Chronic Pain Syndromes 1. Low back pain 2. Upper backpain due to Fibromyalgia 3. Chronic Tendonitis 4. Shoulders 5. NeckDiabetic Ulcers 1. Toes 2. Heel 3. Calf 4. Tibial surface 5. Plantarsurface Venous Insufficiency 1. Stasis Ulcers Pressure Ulcers inImmobile Patients 1. Heel 2. Greater Trochanter 3. Sacrum 4. IschialTuberosity Bone Fractures 1. Feet - “marching fracture” or “diabeticfracture” of metatarsals 2. Avulsion fracture distal fibula 3. Femur midshaft fracture 4. Femur impacted head fracture 5. Radial head fracture6. Humeral head fracture 7. Humeral mid shaft fracture 8. Navicularfracture in wrist 9. Traumatic compression fracture in lumbar spine 10.Traumatic compression fracture in thoracic spineOsteoporosis/Osteoarthritis/ Degenerative joint disease 1. Spontaneouscompression fracture in lumbar spine 2. Spontaneous compression fracturein thoracic spine 3. Chronic hip pain from osteoporosis 4. Degenerativearthritis knee 5. Degenerative arthritis hip 6. Degenerative arthritisankles 7. Osteoarthritis hand 8. Generalized bone healing (not adiagnosis) Ischemic Rest Pain due to Arterial Insufficiency 1. Feet 2.Calf 3. Thigh Disuse atrophy 1. Bedfast conditions - lower and upperextremity wasting 2. Muscle wasting conditions such as multiplesclerosis 3. Muscle atrophy 4. Parkinsonism dementia Paraplegia andQuadriplegia 1. Ischial tuberosity decubitus from wheelchair RepetitiveStress Syndromes 1. Carpal Tunnel syndrome 2. Lateral epicondylitis(Tennis elbow) 3. Medial epicondylitis (golfers elbow) 4. PlantarFasciitis 5. Costochondritis Traumatic Peripheral Nerve Injuries 1. Hand2. Forearm 3. Upper Arm 4. Lower legs Sports Injuries & AcuteSprain/Strain 1. Ankle lateral sprain first or second degree 2. Kneestrain medial or lateral collateral ligament 3. Wrist 4. Shoulder strain5. Elbow 6. Neck acute cervical strain 7. Pulled HamstringMiscellaneous 1. Brown recluse spider bites 2. Localized second andthird degree burns - can't code 3. Post radiation burns ulcerated orpoorly healing 4. Stasis ulcers due to venous insufficiency 5. Postpolio syndrome 6. Lymphadema 7. Post radiation treatment trauma 8.Malignant tumors in conjunction with chemotherapy

Thus, it is apparent that there has been provided, in accordance withthe invention, a procedure and machine that fully satisfy the objects,aims and advantages set forth above. While the invention has beendescribed in conjunction with a specific embodiment thereof, it isevident that many alternatives, modifications and variations will beapparent to those skilled in the art and in light of the foregoingdescription. Accordingly, it is intended to embrace all suchalternatives, modifications and variations as fall within the spirit ofthe appended claims.

1. A procedure for therapeutic treatment of human and animal tisuescomprising the steps of: identifying the tissue to be treated;sandwiching the identified tissue between one or more pairs of opposedemitter pads in contact with the skin; and applying a biphasic faradicpulse sequence to the pairs of emitter pads to stimulate deep layeredmuscle contractions in the identified tissues.
 2. A procedure accordingto claim 1, said biphasic faradic pulse having a waveform with a dutycycle of approximately a 1.5 seconds on and 1.5 seconds off.
 3. Aprocedure according to claim 1, said biphasic faradic pulse having awaveform with a repetition frequency of approximately 57 Hz.
 4. Aprocedure according to claim 1, said biphasic faradic pulse having awaveform with a pulse width of approximately 110 microseconds.
 5. Aprocedure according to claim 1 further comprising the steps of: settingthe intensity of the biphasic pulse sequence at an initial level; andincrementally increasing the intensity in response to the tolerancelevel of the patient.